How to deal with ectopic pregnancy

Assisted Reproductive Technology: A group of infertility treatments in which an egg is fertilized with a sperm outside the body; the fertilized egg then is transferred to the uterus.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tube: Tube through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Hormone: A substance made in the body by cells or organs that controls the function of cells or organs.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Pelvic Inflammatory Disease: An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

In an ectopic pregnancy, a fertilised egg starts to grow somewhere other than in the normal lining of the womb, usually in 1 of the fallopian tubes. Ectopic pregnancy affects around 1 in 100 pregnancies.

An ectopic pregnancy creates a potentially life-threatening situation for the mother, so it is very important that it is treated quickly. Unfortunately, it is not possible to save the pregnancy if it is ectopic. This can be difficult to come to terms with. You can talk to a Tommy’s midwife about what you’re going through for free. You can call them on 0800 0147 800 (Monday-Friday, 9am-5pm) or email them at [email protected] All our midwives are trained in bereavement support.

What causes ectopic pregnancy?

Any woman can have an ectopic pregnancy. In fact, about a third of women who experience an ectopic pregnancy have no known risk factors. But there are some things that may increase your risk of having an ectopic pregnancy. These include:

• pelvic inflammatory disease (inflammation of the female reproductive system, usually caused by a sexually transmitted infection)
• previous ectopic pregnancy (the risk of having another ectopic pregnancy is around 10%)
• previous surgery on your fallopian tubes, such as unsuccessful female sterilisation
• fertility treatment, such as IVF 
• getting pregnant while using contraception such as an intrauterine device (IUD) or intrauterine system (IUS) for contraception 
• smoking
• age (the risk is highest for pregnant women aged 35 to 40).

What are the signs and symptoms of an ectopic pregnancy?

Contact your GP or call NHS 111 if you have a combination of any of the below symptoms and you think you might be pregnant, even if you haven't had a positive pregnancy test.

Symptoms of an ectopic pregnancy usually develop between the 4th and 12th week of pregnancy.

Vaginal bleeding

Vaginal bleeding in pregnancy tends to be a bit different to your regular period. It often starts and stops, and may be watery and dark brown in colour.

Vaginal bleeding in pregnancy can be common and isn't necessarily a sign of a serious problem, but you should always get medical advice if you have it.

Stomach pain

You may have stomach pain, typically low down on 1 side. It can develop suddenly or gradually, and may be persistent or come and go.

Any stomach pain may just be caused by a stomach bug, trapped wind or something unknown. But it is important to get medical advice if you have it.

Shoulder tip pain

Shoulder tip pain is an unusual pain felt where your shoulder ends and your arm begins. You should get medical advice right away if you experience this.

We don’t fully understand why this pain happens. It is thought to be linked to the presence of fluid or blood leaking into the pelvis or lower abdomen, which happens in an ectopic pregnancy. There are nerves in this area that are linked to your shoulder. Irritation of these nerves can lead to shoulder tip pain.

Discomfort when going to the toilet

You may have pain when going for a wee or poo. You may also have diarrhoea or constipation.

Some changes to your normal bladder and bowel patterns are normal during pregnancy. These symptoms can be caused by urinary tract infections and stomach bugs. But it's still a good idea to get medical advice.

Symptoms of a rupture

In some cases, an ectopic pregnancy can grow large enough to split open the fallopian tube. This is known as a rupture.

Ruptures are very serious. Surgery to repair the fallopian tube needs to be carried out as soon as possible.

Signs of a rupture include a combination of:

• a sharp, sudden and intense pain in your tummy
• feeling very dizzy or fainting
• feeling sick
• looking very pale.

A rupture can be life threatening, but fortunately they are uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK.

How is ectopic pregnancy treated?

Unfortunately, the only way to treat an ectopic pregnancy is to end the pregnancy. This can be very distressing, and you may need support afterwards to come to terms with what has happened.

Your healthcare team will talk to you about your options and what this means for you. Not all these options will be suitable and will depend on:

• how many weeks pregnant you are
• your symptoms (for example, how much pain you are in)
• if there is a lot of bleeding in your stomach
• your hCG levels (the pregnancy hormone)
• what is available at your local hospital.

It’s important that you understand all your options and what this may mean for you and your ability to get pregnant again (if you want to). Don’t be afraid to ask as many questions as you need to and raise any concerns you have about what is happening.

There are 3 treatment options for an ectopic pregnancy.

Expectant management

Expectant management means waiting for the pregnancy to end by itself naturally (miscarriage), without treatment. It is usually only possible when the pregnancy is still in the early stages and when you have a few or no symptoms.

Your doctor will need to check your hCG levels (pregnancy hormones) every few days until they go back to normal. This is to make sure that the pregnancy has completely ended. You may need more ultrasound scans.

Find out more about expectant management.

Medication 

You will be given medication as an injection. This stops the pregnancy from developing and it will gradually disappear. If you are given medication, your fallopian tube is not removed.

You may need to stay in hospital overnight. Many women are in some pain for the first few days, but this should settle if you take paracetamol.

You will need to go back to hospital in the first week and then once a week to check your hCG levels. It may take a few weeks make sure the pregnancy has completely ended and you may need further ultrasound scans. During this time, you should not have sex. You should also avoid getting pregnant by using reliable contraception for at least 3 months.

Some women who take medication may still need surgery.

Surgery

The aim of surgery is to remove the ectopic pregnancy. The surgery will be either be a laparoscopy (a type of keyhole surgery) or a laparotomy (open surgery). It may take longer to recover if you have open surgery.

You may have your fallopian tube removed (known as a salpingectomy). This will reduce the risk of having another ectopic pregnancy next time. 

If you only have 1 tube or your other tube does not look healthy, you may be advised to have a salpingotomy. This operation aims to remove the pregnancy without removing the tube. This means that you have a higher risk of another ectopic pregnancy, but you will still be able to get pregnant naturally.

You may be offered a follow-up appointment with your gynaecologist, particularly if you have had an emergency operation. If you have not had your fallopian tube removed, you will need to have your hCG levels checked until they are back to normal.

In an emergency

If the fallopian tube has ruptured, you will need emergency surgery to remove the ruptured tube and pregnancy. Your doctors will need to act quickly, so they may have to decide to operate for you.  

Will I still be able to have a baby in the future?

For most women, an ectopic pregnancy is a ‘one off’ event and does not happen again. Even if you have only one fallopian tube, your chance of getting pregnant again is only slightly reduced.

If you do get pregnant again, you may be offered an ultrasound scan at 6 to 8 weeks to confirm that the pregnancy is developing in the womb.

Talk to your GP if you do not want to become pregnant again. Some forms of contraception may be more suitable after an ectopic pregnancy.

How you may feel about an ectopic pregnancy

Having an ectopic pregnancy can have a huge impact on your mental health. Everyone is different but you’ll likely have lots of feelings and emotions and may need time to come to terms with the loss of a baby. Some women might also need time to accept that they could also have lost their life.

You may eventually want to try for another baby. Try to remember that the possibility of a normal pregnancy next time is much greater than the possibility of having another ectopic pregnancy.

You may find it helpful to:

• talk to your partner, family or friends about how you feel
• ask your care team what support is available – they may refer you to a counsellor who specialises in support for people affected by ectopic pregnancies
• talk to a Tommy’s midwife free of charge from 9am–5pm, Monday–Friday on our helpline 0800 0147 800 or email [email protected]
• visit The Ectopic Pregnancy Trust for more support and information.